B.C. Senior's Advocate Isobel Mackenzie.

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THOMPSON-OKANAGAN - The person in charge of looking out for seniors across the province believes more could have been done to prevent a Salmon Arm man’s death, and hopes lessons can be learned from the tragedy.

B.C. Senior’s Advocate Isobel Mackenzie believes hospitals should follow a uniform discharge process to help ensure vulnerable patients make it home safely. That checklist, she says, should include phoning the patient’s residence, or a family member, and could have made a difference for Salmon Arm man Christopher Allbury.

The 70-year-old suffered from alcoholic dementia, and lived independently at a congregate living home with some supports but no constant supervision. He went to the hospital one night in early May complaining of a sore knee, but was discharged around midnight. The hospital gave him a taxi voucher, but didn’t call his residential facility to let them know of his return. Instead of making it back to his apartment, Allbury wandered off and was found dead in some bushes two weeks later.

“There should be a checklist. They should have phoned. There should have been a ‘we can’t release you until X, Y and Z,’” Mackenzie says. “I think clearly there are lessons to be learned and things that could have been done to prevent this.”

She’s visiting hospitals around the province and working on ‘tightening up the process’ to make the discharge process more uniform.

“(It’s) for frail and vulnerable people of any age when they’re discharged. The same would apply for a cognitively challenged 38-year-old as to a physically frail or cognitively challenged 98-year-old — there needs to be a checklist, whether it’s phoning where they live to let them know they’re arriving, or making sure that when they say ‘my wife is home’ that she is there and that she’s competent to take care of them,” Mackenzie says.

Allbury’s brother says they were trying to get him into a full-care facility, somewhere with supervision and more safeguards in place, but those efforts were cut short by his death.

A COMPLEX CASE

It’s not the first time we’ve heard about things going awry for seniors with dementia living more or less independently in the community. In Kamloops, two sisters question why their mother — a smoker who died when her chair caught fire — wasn’t put in a care home and was instead left to live on her own with minimal supports. In Enderby, another woman who lived alone and had been diagnosed with dementia drove far from home in a truck she was told not to drive and was eventually found dead on the side of a rural logging road.

“It’s a little more complicated than saying ‘she should have been in a care facility,’” Mackenzie says of the Enderby incident. “It’s not that straightforward.”

Compared to 40 years ago, Mackenzie says more seniors are choosing to keep living in the community with health care supports like care aides, instead of being put in care homes.

“Staying in the community is what people want. They want to stay at home,” Mackenzie says. “That’s not as controlled and secure as being in a care facility.”

Without constant supervision, the chances of a patient wandering off and getting lost — potentially with tragic consequences — goes up. That’s perhaps part of the reason why nearly half of families caring for a loved one at home would prefer they be admitted to a care home.

“We know about 48 per cent of family members who are caring for somebody at home who has moderate to severe cognitive impairment actually believe they would be better off somewhere else,” Mackenzie says.

Of that 48 per cent, only 20 per cent of patients themselves believe they should be put in a care facility.

“They don’t want to go, and if somebody doesn’t want to go into care and resists, that’s a very difficult situation,” Mackenzie says.

No one, not even family members, can force an individual into care. The only time it can be done is if, under the Mental Health Act, a patient is deemed incompetent and unable to make decisions.

“It’s a fairly high bar, because what you’re doing is taking away someone’s liberties,” Mackenzie says.

LOWERING THE RISKS

There are ways to reduce the risks for seniors living on their own with cognitive impairment. GPS bracelets and home monitoring systems are some of the devices available to help families keep an eye on their loved one, Mackenzie says. It’s also important that everyone from family members to physicians and care aides monitor patients regularly to assess their condition.

“Dementia is a journey and what becomes challenging is monitoring people on that journey to find the time when in fact it’s no longer safe or appropriate for them to live in the community,” Mackenzie says. “You have to make sure care aides are trained and that there are feedback and reporting mechanisms in place, and sometimes things fall through the cracks there.”

She says care aides are looking after a larger number of clients with complex care, and yet their training hasn’t fully caught up.

“I think that we can probably look at some better training for care aides to make observations and then have a very specific reporting mechanism,” Mackenzie says.

Still, she says living in the community will always have more inherent risks than living in a care home and that must be weighed carefully with a patient’s desire for independence.

“The perspective of my office and arguably the public, is it’s important that people understand the risks and are making informed choices to live with those risks,” she says.

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